CHAPTER 4
NATIONAL PRIORITIES IN HUMAN DEVELOPMENT

Education

The educational system also provided a satisfactory level of training at higher educational establishments and secondary schools. All expenditures related to higher and secondary specialized education were covered by the State. Of course, there were drawbacks as well. Relative to the more developed areas of the USSR, Kyrgyzstan had relatively low levels of material basis, teacher qualification, and, subsequently, specialist training in spite of incentives provided by the State to improve the educational level in this region. It is certain that communist ideology and the totalitarian regime were influential. Knowledge was taught purposefully in a curtailed manner; both students and faculty received only limited information. Educational objectives established according to "guidelines pursuing the utmost interests of the state, its security, and purity of the Marxist-Leninist ideology", were implemented in isolation from the rest of the world.

School Attainment in 1989

What does the Kyrgyz Republic have today? The number of pre-school institutions has been drastically reduced. In 1990 new pre-schools had places for 7,200 students, in 1993 new pre-schools accommodated only 420 students. Moreover, the national and local government have been unable to finance pre-school institutions due to increasing operating costs. Parents are usually not able to pay high fees and many pre-schools have closed, the buildings sold and used for other, usually commercial, purposes. The number of pre-schools decreased from 1,398 in 1985 to 998 in 1993.

In 1993, comprehensive day schools were attended by 938,400 students, that is, 21 percent of the total population. However, new comprehensive schools in 1993 accommodated only 8,400 students only one-fifth the capacity of schools opened in 1990. There are 1,884 comprehensive schools including 28 evening schools. Seventy-seven percent of the day schools are operating in 2 and even 3 shifts to accommodate the number of students. In 1993, State expenditure on education averages 126 soms per student.

Rural regions, with generally higher birth rates and greater proportions of young people in the population, have the highest number of students per 10,000 population. The number of students per school is highest in Bishkek and lowest in Chui region. The average number of students per teacher in the entire country is 12. The ratio is higher in Bishkek and Chui region, 16 and 14 respectively, though still extremely relative to most countries.

Those figures do not give a complete picture of the schooling situation in the Kyrgyz Republic. In spite of the low student to teacher ratios, class size is actually much higher, usually 25 to 30 students. Many school buildings are in very poor condition. The lack of places for students affects the quality of teaching and forces schools to operate two to three shifts. Operating multiple shifts adds to the burden of the teachers when they have to teach more than one shift a day. It is also a burden for the students, especially in rural areas and especially during the winter, when they must walk to or from school in the dark.

General education is funded from the local government budget and local governments are responsible for the preparation and execution of that budget. The Ministry of Education establishes standards for all budget items allowing for some difference across areas due to differences in development levels. In some regions local budgets are insufficient to cover general educational costs because of the economic crisis.

Most local governments lack the funds necessary for proper maintenance, not to mention the construction of new facilities. Several existing schools are in need of urgent repairs and school constructions have been left unfinished. The completion of schools under construction should be a high priority of the government, donors and sponsors. There are many such schools and the need for the new facilities is acute throughout the country but especially in rural areas where schools are, for the most part, in very poor condition. There is not even enough money to conserve what has been built and building materials are often simply stolen. Schools are no longer able to supply students with textbooks and other materials. Printing of textbooks in the country has been drastically limited due to the shortage of funds and raw materials, mainly paper.

Schools are experiencing an explicit shortage of teaching staff both in the countryside and in the urban areas, especially in the remote districts. Teachers leave the profession because of the low salaries and inadequate working conditions and others emigrate. It is not unusual for students to receive their secondary education certificates with subjects missing simply because there was no teacher for certain subjects. The quality of teaching in many schools has deteriorated to the extreme. Several cases have been reported when certificates and examination marks have been simply bought.

Another result of the shortage of funds for schooling is that children are deprived of school meals. Student from high-altitude and pasture-land localities, for whom boarding schools were opened, have been receiving much less assistance than they need. Out of 38 boarding schools that were operating in 1992, today only 32 remain open and they are struggling. The number of students has fallen from 11,700 down to 8,900. This problem affects most directly the remote areas of Naryn, Talas, Osh, and Djalal-Abad Regions.

One School's Story

The lack of funds, schools, materials and teachers affect school attendance and have contributed to the increase in the rate of drop outs that has been observed recently.

There were 11,900 students registered in the country's 51 secondary specialized educational institutions in 1993. The system of secondary technical education is relatively small but, nevertheless, comprises professional schools, technical schools, and vocational schools. In these schools students receive more specific training. Some government ministries run their own training and re-training courses.

The system of technical education faces serious problems. In the short-term, there is an acute shortage of funds. In the intermediate term there is a need for complete modernization. It will be necessary to reorient the entire secondary specialization system to meet the needs of enterprises and government departments in the market economy. This re-orientation will require the re-training of technical school faculty and management.

At this juncture, it may be advisable to reconsider the placement of secondary special schools across the regions of the Republic. Currently Osh region contains 35.1 percent of the student places in secondary special schools but only 30.7 percent of the nation's secondary school students. Osh contains 8 secondary special institutions, the same number as in Djalal-Abad and Chui regions that have 19.9 and 14.6 percent of secondary school students, respectively.

The large number of secondary special schools in Bishkek, and the higher average quality of material and teachers explains the fact that students come from the whole Republic to study here. At the same time, there is a certain logic to widely distributing secondary special schools and training specialists. The creation of regional educational cultural centers creates an atmosphere of learning and it brings students and trainers closer to the enterprises that will be "consuming" the graduates of the secondary special institutions. Furthermore, it is not difficult to supply reasonably qualified teaching personnel to the regions.

The situation is different for higher learning. In that case, the formation of centers of higher learning across the whole Republic should not be made an end in itself. The Republic could not provide facilities, materials and professorial staff for each place. Moreover, the demand for graduates with higher education is not so great and widespread as the demand for secondary special graduates.

Higher educational institutions are experiencing difficulties. In 1992 there were 160 Doctors of Science, 1122 Professors, Candidates of Science, and Docents, whereas in 1993 the numbers were 171 and 1038, respectively. The funds available for student stipends, staff training, textbooks and other materials are lacking. As with other teachers, professors are leaving higher educational institutions because of financial considerations and emigration. In terms of average monthly salary and minimal consumption rates, higher education faculty members are falling into the category of low-income. In 1992 there were 232 faculty members per 10,000 students and in 1993 only 231.

Higher Educational Establishments

So, is their ruin lying in front of us?

Of course, the extreme shortage of funds does not allow the State to support education today even at the minimum level. Nevertheless, with the meager funds at its disposal, the State endeavors to soften the worsening situation, provide quality education, and create lasting foundations for the future.

Some reform is underway, new training frameworks are being structured within the Republic and jointly with other countries. Private schools have begun to appear in the Republic. Eight private higher educational establishments, 23 lyceums, 4 colleges, and 9 private secondary schools have opened in the last few years. Private

school constitute a way to reduce state expenditure provided the quality of the education in these institution is thoroughly controlled.

The trend in higher education has begun a retreat from increasing size and concentration. The structure of higher educational establishments is becoming more consistent with its aims; student enrollment more closely reflects actual sectoral requirements. There has been a reduction in the number of successful applicants to existing colleges. In 1993 day-time departments of natural science schools admitted 1190 students, 6.3 percent less than in 1992, due to the establishment of institutes of higher learning.

Education: The Scale of Values

The number of higher education establishments has increased substantially as a result of the division of some existing institutes and the creation of entirely new schools. In 1992 there were 13, in 1993 18, and in 1994 21, higher educational establishments. New higher educational centers have been formed in Osh and Djalal-Abad in the south of Kyrgyzstan. The largest educational center is in Bishkek where there are twelve institutions of higher learning.

The principle of the formation of more compact specialized, dynamic, higher educational establishments and the regionalization of those institutions can be supported. However, it is necessary to ensure that proliferation of higher educational establishments does not become an end in itself. The result does not depend on number, but rather on quality of teaching and training. Consideration of financial constraints must be reflected in the number and size of higher educational establishments. Concentration of efforts in order to better distribute teaching personnel may be advisable.

Three examples illustrate the problem. In the first place, specialists in economics and business are spread over seven higher educational institutions in Bishkek alone in addition to the state and private colleges in Bishkek, Osh and other cities. This distribution of funds has no grounds-- there are not enough professors and teaching staff to provide high quality training in each of those institutions. In the second place, in the euphoria following independence a number of university departments were opened to teach Chinese, Japanese, Turkish and other Oriental languages. With the opening of the Kyrgyz Republic to the world, there is a need for people who know these languages, but we have neither the material basis nor the personnel to support such extensive language training. Third, recently medical departments have been opened in Osh State and Kyrgyz Slavonic Universities, in spite of the very high level of training provided at the Kyrgyz State Medical Training Institute. In addition to the lack of qualified teaching personnel, it is not clear that the need for specialists exceeds the number currently graduating.

A gradual, balanced approach should be taken. The number of students and departments must reflect the size of the country and take into account the availability of funds. It may be more efficient to concentrate qualified teachers in fewer departments rather than to propagate the creation of departments for which there is no qualified instructor. Additional options can be considered, for example in the case of languages, students might be encouraged to study abroad to learn most languages and local universities could strengthen its ability to teach the English language that is of international business, political, scientific and cultural importance.

State budget expenditures for higher education should be reduced. One possibility is for interested organization to sponsor the enrollment of some students. Individual payment for training should also be introduced. Of course, scholarships for students coming from low-income families and as an incentive for excellent students should be made available. In addition to the budget-financed higher educational establishments, contract private departments are being opened and training in some higher educational establishments is essentially paid. An atmosphere of creative competition among the higher educational establishments in the training of specialists in a number of professions is being created. Unfortunately, licenses to open private higher educational establishments are issued with little control and there is concern that the quality of the higher educational system may deteriorate.

There are significant complex problems in the reform of the educational system, especially the shortage of new educational structure programs, of appropriate textbooks and reference-books, and of qualified and competent faculty members. There is a need for training and retraining of the faculty. This retraining of faculty members should precede everything else, because a teacher with obsolete training cannot teach students new knowledge.

In this time of economic crisis, the country lacks the resources to provide new higher educational institutions and departments offering new majors with trained professionals. Cooperative ties should be retained and developed with the CIS countries and with the United States, Germany, Turkey, Japan, China, etc. The most important objective in the educational system today is to maintain overall standards in higher education and to develop a new concept of education and a program of knowledge modernization.

Live Voices

"A doctor is someone who will never be without work provided he is a true professional." Graduate student of the State Medical Institute, age 22

"These days it's most important that one knows English well enough to speak fluently and translate certain documentation." 4th year student, National University, age 20

"I sometimes think that we in fact deceive the Republic when we spend so much time and money to train all these managers, marketing specialists and other professions related to a market economy. Definitely these new spheres have their limits, just as the sphere of law does. We don't have to train too many lawyers. Now the demand is high, but what will become of it in five or ten years?" Minister of Education and Science, age 58

"I had a year of studies in the USA and most certainly will never forget that experience. I learned a lot. At the same time, I'm now in the same year of studies at my home school, because in the USA they have quite different programs and many subjects we have here are not taught there." Secondary school student, age 16

"It's hard for me to judge if theoretical and experimental physics will be of any use in my personal life. Once I thought that I could pursue post-graduate education, but now I have doubts about the prospects of science in this country. May be for that one has to go abroad, but I could not afford that." 4th year student, National University, age 20

Science and Technology

The scientific and technological development in Kyrgyzstan did have some drawbacks and faults typical of the whole "Soviet-style" science. The basic problem was isolation from the world scientific community. Because of limited contacts for the exchange of information and inadequate knowledge of Western technologies, local research fell behind. Weak links between science and production meant that local industries did not get adequate technological designs. Pure research was relatively well-known, but it was not the same with applied and technological research.

The institutes of the National Academy of Sciences have introduced into sectoral production 130 scientific designs. The Geological Institute of the NASc of the Kyrgyz Republic at present is a universally recognized Central Asian leader in the field of Pre-Cambrian geological research significant for major mining industries including gold, platinum, uranium, nickel, cobalt, and iron. Pre-Cambrian studies play an important role not only for theoretical, but also for practical science, providing geologists with tools that facilitate the survey of the prospective mineral deposits. In 1993, scientists compiled the first Geodynamic Map of Kyrgyzstan, scale 1:500,000, and a Metallogenic Map of the same scale. These maps are unique in the CIS region in terms of the basis principles and in terms of the level of precision. The Metallogenic Map will serve as a basis for mineral survey forecasts; the known deposits are just a small fraction of the overall potential for the Republic.

The Institute of Mining Physics and Mechanics has also attained a well-based reputation both in CIS and world-wide. Another entity, the Institute of Machinery, is unique both in terms of its internationally recognized contribution to the theory of machinery research and in the supply of mining technology for countries throughout the CIS. There is, in fact, a whole branch of mining-oriented institutes whose designs and projects are of national and international significance. Fuel is an important national economic issue today and research is being conducted on ways of better exploiting the coal potential of the country.

The Mountain Area Soil Research Institute has conducted a vast amount of research including the development of a soil cadastre map of the Kyrgyz Republic that can be used to estimate the viability of grain and cattle production in a given soil area for example. The land of Kyrgyzstan can provide enough food for its population, provided it is utilized effectively and efficiently.

What is the situation with science and technology today? The new situation poses new problems. The Kyrgyz Republic has attained its independence, established statehood, and adopted a new value orientation and a new way of economic life. Since opting for democratic reconstruction of its society, this country's pressing need is to maintain and promote social and economic sciences. The scientific and intellectual potential of the country is quite capable of solving complex theoretical, applied, technological, technical, social and economic problems.

The deep economic crisis in the transitional period has impeded the economy's development. Funding for scientific research is scarce and unstable. There are no funds to purchase scientific literature, equipment, and chemicals. The lack of funds impedes the institute's ability to carry out on-site research and maintain existing research facilities, to say nothing of building new ones. Low salaries cause many research staff to emigrate or go into commerce. From 1991 to 1993 the staff of the National Academy of Sciences shrank by 23 percent.

The State cannot provide sufficient funding to science, thus an attempt is being made to upgrade the return coefficient in the science sector and preserve the talented research personnel. There is a search underway for various ways in which science could adjust itself to the market, as well as for additional or alternative financial sources. One promising possibility is to obtain research orders from international and foreign clients including governments, scientific institutes, industrial and commercial enterprises, and international funds and organizations. Another possibility is to allow local staff to work overseas on fixed-term contracts while on leave from their home research institution. A third possibility is the formation of commercial and industrial structures in science. Unfortunately, current prospects for this option are limited by the decline in production and the lack of demand for scientific commodities even of applied character. The search is underway to merge science and the market. An immediate break-though is unlikely but the country cannot bide time waiting for the situation to resolve itself. Efforts must be made to preserve the scientific research human resources. The greatest danger is the loss, to the country and to the international scientific community, of the experience and expertise of scientific personnel.

Culture

When we speak of cultural development in the Republic we think in the framework of overall cultural stock that has been accumulated within its nation in literature, painting, sculpture, theater and cinema, music - in terms of quantities of masterpieces. Thus we speak of one sphere of human activities. The criterion for the cultural level of a nation, to our mind, is not defined solely by the amount of books being published, movies, theatrical performances produced, canvases and sculptures created, or by the amount of theaters, movie studios and theaters, museums, TV- or radio-stations, libraries, and culture palaces. However, one has to take all this into account, these places serve as the premises for formation of a nation's culture and in that respect are relevant.

As a result of the dissolution of the Soviet Union, artistic ties between theatrical teams, composers, artists, musicians and their colleagues in other CIS republics have been curtailed. This has narrowed the artistic scope and vision and diminished the repertoire of local artists. In addition, art is becoming more entwined with ethnic repertoire and this should cause concern. National isolation in arts makes them shallow and affects the nation's spirit. Amateur art cannot replace professional art in adequately meeting the spiritual demands of the nation that are oriented towards understanding the world's cultural masterpieces. Retreat from professional art is disastrous for the spiritual revival and purification that several generations of Kyrgyz society found at the Kyrgyz Academic Theater, the Kyrgyz Academic Drama Theatre and the Russian Academic Drama Theater.

Sponsorship of culture is limited. Leading performers in the theater are paid 400-500 soms per month, an amount that is not adequate for living and artist conditions. Many cultural leaders, artists, actors and musicians have emigrated and among those who remained, many have been forced to take other jobs for economic reasons. The loss of these leaders leave higher educational institutions incapable of adequately training aspiring artists.

The number and usage of cultural institutions in the Kyrgyz Republic over the years since independence is not encouraging. The Kyrgyz government allotted 70.3 million som for cultural activities, aesthetic education, and mass media in 1994, a ten percent increase in real terms over 1993. Nevertheless, from 1989 to 1994, many cultural establishments have closed due to financial difficulties. The number of libraries in the Republic fell from 1735 in 1989 to 1401 in 1994 and the number of visitors decreased by 19 percent. The number of cultural clubs fell from 1175 to 973 during the same period. A chronic lack of funds also leaves many cultural buildings without maintenance.

The number of theaters has actually increased but the number of annual visitors has fallen to just a third of the 1989 level. Some independent theaters have opened and yet none has been provided with the minimally sufficient funding. In the past students and intelligentsia were attracted on a mass scale to theaters. Any visit to a theater would be a joyful event and theaters were full to capacity. Today they barely fill half of the house. It is not good for the artists who are only receiving a miserly salary. State officials tend to attend theatrical performances only on official occasions where the show contains the same official repertoire. This leads to spiritual degradation of the 'nomenclature', the general population, and the theater itself. Education through art is literally passing away. Cultural and spiritual ideology has ceased to be. Under the 'socialist regime', the official policy of the Soviet Government would limit, but not block the way for world art. Today, when the way is open completely, we give up culture ourselves, having developed no specific policy of spiritual development on the basis of democratic and universally humane culture. No financial problems can justify this inability to comprehend this world's soul.

There has been an increase in the number of museums since 1989 but, again, the number of visits fell by ten percent. There has been a drastic reduction in both the number of and visitors to Cinemas. Publishing, both newspapers and books has suffered from a lack of paper. Books and brochures published in 1993 comprised 402 printed units, less than 40 percent the 1989 number. The increase in printing costs has resulted in an 80 percent decrease in the number of copies of newspapers produced annually from 1989 to 1993.

Man's culture accumulates in itself his educational level, his general outlook, perception of the world, morals, ethics, social attitudes, attitudes to his own duties, comprehension of the degree of social responsibility, as well as an eternal quest for physical perfection and beauty. In a person everything should be beautiful: mind, body, soul, deeds.

Cultural institutions, like educational and scientific organizations, must begin to exploit the market economy to support their activities. The young are potential consumers of a wide range of cultural activities. There has been an introduction of international mass culture in response to pressure from this audience. People are spending money on the mass culture. The State has taken no interest in the development of this sphere. However, if it did it could use the mass culture to educate, direct, and inform, preserving the expressiveness, emotions and dynamics of the mass culture, but removing its aggressiveness and nakedness.

When literature is replaced with low-quality imitations, kind and wise films are forsaken for sex-and-violence, alcohol addiction is growing, prostitution is becoming a norm and there is an increase in sexually transmitted diseases and the danger of AIDS, cruelty wins, homicide rates are growing, mistrust and evil prosper, how can one speak of cultural enrichment, either personal or national? To halt these trends there are two things that must be done. The first is a state moral social ideology. The second is the preservation and improvement of the cultural basis. In a broad sense, this includes science and education, culture and health care, all the elements of the social sphere. They are all important for the cultural and social well-being of the nation.

In order to financially support the social sphere, the State could launch a social support government loan program whereby bonds in 100, 1,000, and 10,000 soms denominations could be sold. The State could fix a maturity term for these securities of a year after the date of issue because a longer maturity term could not be proposed in such difficult times. A portion of the profit on the bond sale should then be spent in the social sphere. The remainder must be invested in order to repay the principal and interest on the bonds. In order to interest people in the loan program, 'sliding' interest rates could be used, depending on maturity terms, higher dividends for longer terms. All possibilities should be employed to prevent a complete collapse of the social sphere.

"Among the priorities of 1995 I would, with no hesitation, rank first the objective of reducing and eventually correcting the industrial production sector decline." Deputy Minister, age 54

"The highest priority are food products and the minimum funds for their purchase. To provide for this minimum is to avoid the most dangerous social consequences of the crisis." School Principal, age 40

"Stable job and wages - this is my personal priority for 1995." Agricultural Machinery Production Plant Worker, age 39

"In 1995 I hope to enter a University, I am glad the choice is so varied these days. I think the priority for anyone is get professional education. Some would need to get training for a second profession." Last-year secondary school student, age 16

"The real priority for Kyrgyzstan is a successful foreign policy which would be conducive to new credit lines, good terms with neighboring countries, respect and attention from the UN." Special Envoy for Kyrgyzstan, age 42

"In fact the unemployed in Kyrgyzstan are more numerous than those with jobs. The destiny of those who do not work but study, bring up children, or are on pension is the priority for the State financial policy. It's so sad when the Government does not understand this in full." National Academy of Sciences Corresponding Member, age 62

Preservation of Health

There were undoubtedly shortcomings in the development of the health care system in the Soviet period of Kyrgyzstan. Health care was often financed out of what was leftover in the budget after all other expenditures. Though the medical training institute produced many highly qualified doctors and specialists, graduation requirements were not high. Nevertheless, the mortality rate in general and for many diseases dropped steadily.

The situation has drastically changed for the worse recently. Quack doctors and untested methods are becoming widespread--before they were strictly forbidden.

One of the most comprehensive indicators of the overall health care performance and standard of living in general the is average life expectancy of the population. Life expectancy in the Kyrgyz Republic was 68.3 years in 1992, 72.2 and 64.2 years for men and women, respectively. These figures are lower than those for wealthy, economically developed countries, yet higher than those for many developing countries. However, there has been a tendency for life expectancy to decrease. During the years of Kyrgyzstan's political and economic independence, the average life expectancy has fallen from 1991 to 1193 by 0.8 years, with women having lost 0.7 and men 0.9 years. This may reflect the general decline in living standards and lower efficiency and effectiveness of the health care system. However, it is partly caused by the increased stress of the contemporary world and an increase of environmental diseases such as cancer that are beyond the control of the health care system.

In 1993 approximately 1.8 million people apply for medical aid in polyclinics and more than 300,000 in hospitals. This figure is not expected to decrease and may increase in spite of the reduction due to emigration. There may also be an observed decrease because the lack of medicine and medical supplies compel people to resort to self treatment and refuse the service of doctors. On the other hand, the general deterioration in standard of living will increase the number of patients and the demand for medical services. Estimated expenditure for the next years will be based on the annual requirements of 1.5 million needing medical aid.

Hospitals no longer provide medicine and medical supplies. The medical service is gradually introducing charges. This trend should be standardized legally. It is not necessary to await the construction of new polyclinics and hospitals, fees for services can be introduced into existing clinics and hospitals. These fees should take into account the level of income of the patient, for low income people, free medical service may be preserved.

To this end, the medical card of each patient must contain data on the family income. Special consultative offices for which there would be a fee could be established in existing polyclinics and hospitals. These offices might offer longer examination periods and additional services for those who could pay. Private practice must be permitted to a greater extent, though there should be some government monitoring of the quality of service in private offices. If the medical service is to survive, an alternative must be found to cover expenditures that the state can no longer fund.

The situation with the spread of venereal diseases has become especially acute. The incidence of syphilis of various forms has been rapid in its growth. Elderly doctors still remember that in past years it was difficult to demonstrate to the students syphilis patients, they were so few. The incidence of venereal disease has increased and this is connected with the fact that the conditions of the market economy directly affect the sexual aspect of human existence. In 1990 the number of registered syphilis patients was 86 and in 1994 it was 1,044. Diagnosed cases of gonorrhea increased from 2,554 in 1990 to 2808 in 1994. Prostitution has become a widespread phenomenon in the urban areas. There is no morality police, no regular medical examinations of known prostitutes, a lack of medicine, and doctors charge for the treatment of venereal diseases. The results are dangerous. Though not a single AIDS case has yet been registered in the Republic, there is a well-grounded supposition that there are perhaps a dozen cases and the task is to find them in time.

There has been a sharp decline in the material basis, equipment, medicines and medical supplies in polyclinics and hospitals. In 1993 new hospitals contained only 176 beds, hospitals built in 1990 increased capacity by 1,045 beds. Similarly dispensary clinics increased their capacity much less in 1993 compared to 1990. In 1993 the capacity of the dispensary departments under the Health Ministry was 61,471 visits per shift, 8.5 percent more than in 1990, but still inadequate for proper handling of this countries' medical needs.

Medical personnel are trained at the State Medical Institute, at the Medical Department of the Kyrgyz Russian Slavonic University and at the Medical Faculty of the State University of Osh. The Republic has a network of secondary medical schools that train medical nurses and assistants. In the past, many physicians received their education outside of the Republic, in Moscow, Leningrad, Almaty, Tashkent, Kiev and other cities of the former Soviet Union. In 1993 in the Kyrgyz Republic there were 33.4 qualified physicians and 96.1 middle level medical personnel for every 10,000 people, which is 9 and 8.4% less than the corresponding figures for 1990. The worsening economic situation and the low salaries force medical personnel to leave their jobs. This is especially true for medical nurses. Medical service standards can be upgraded only when the profession of a physician is regarded not only as humane, but also as an esteemed and well-paid occupation. Those working in remote parts of the country should receive an appropriate bonus compensation.

One of the serious drawbacks of the development of the health care system in the former Soviet Union was the low level of medical service coverage for remote rural areas in the Republic. This disadvantage has grown in the years since independence. Ideally, every village should have its own physicians: a therapeutist, surgeon, midwife, pediatrician, etc. Only in rural district centers is such a set of medical personnel available, some villages have no medical personnel at all.

Djalal-Abad and Osh regions have the lowest number of doctors per capita. The relatively developed Chui region is not sufficiently provided with doctors. Per capita availability of hospital beds is lowest in the three regions of Issyk-Kul, Naryn and Osh.

One of the major objectives of the health care system is to ensure and enhance children's survival, to reduce child mortality rates and extend healthy life for both the young and the elderly.

In 1993, children who died before the age of 1 comprised 31.9 per every 1,000 born, a rate slightly higher than that for 1990, 30.0. In 1994 the infant mortality fell slightly to 29.4. These rates are much higher than those of industrial countries. The comparisons to such countries are difficult, the worsening situation in the Republic is a serious warning in a country with a high birth rate.

The most important single cause of infant mortality is acute pneumonia. The rates reach their peak during the winter months and especially in rural areas where climatic conditions are more severe, dwelling standards low, medical services not available. The general education level in rural areas is considerably lower than in urban areas and hinders appropriate diagnosis of such diseases. The second most important cause of infant mortality is perinatal conditions that accounted for 79.5 deaths for 10,000 live births in 1993.

Maternal mortality is relatively high in the Kyrgyz Republic. From 1979 to 1989 it was significantly higher than that for many other regions of the Soviet Union including Ukraine, Belorussia, Georgia, Moldova, and Lithuania. According to some experts, maternal mortality may even by higher than indicated as a result of inconsistent cause of death registration. Some deaths resulting from childbirth were recorded as sepsis, or high blood pressure. The maternal mortality rate has fallen from 62.9 deaths per 100,000 births in 1990 to 44.5 in 1993.

One should note the high rates of diseases bringing forth temporary physical disability. Influenza is an important health problem in the Kyrgyz Republic. There were 93,778 registered cases in 1993. Viral hepatitis is another health problem; there have been nearly 20,000 cases reported annually since 1990 when there were 27,866 reported cases. Incidence of measles increased sharply in 1993 but then decreased in 1994.

Among the major achievements of the Soviet Union was the provision of a centralized water supply to over 80 percent of inhabitants in both rural and urban areas. The situation has begun to deteriorate. Water pipelines require continual investment to replacement and upgrade the pipes and filter systems. In Bishkek alone there is a need for replacement of more than 200 kilometers of pipeline segments that were put in use 42 years ago. Even more problematic is the situation outside of Bishkek. Previously, all water facilities were kept by the collective farms. The dismantling of those farms has resulted in a reduction of the funding for the water supply systems and a deterioration of the quality of water processing. This represents a danger of an increase in intestinal infections and child mortality rates.

Malaria which seemed to have been eradicated for good may again become a public health threat. Many of the preventive measures such as locating rice patties at least 3 kilometers away from any settlement have been recently considered unnecessary. The authorities responsible for these issues must take immediate action to enhance sanitary and epidemiological control and to increase funding of preventative measures. Economizing on those measures inevitably results in loss of human life and the need to spend great amounts to remedy the epidemic situation after it has got out of hand.

A quite unique situation is with the problem of AIDS monitoring and control. No AIDS cases have been registered so far in the Kyrgyz Republic. However, funding of measures to prevent its appearance and spread could have an extremely important effect upon this country's population's health.

Since the country has become more accessible to international travel, the danger of the spread of infectious, including epidemic, diseases can be controlled only by well-organized and permanent prophylactic measures such as mass immunization. The introduction of health status certificates is one example of measures that could be taken to prevent the spread of disease.

Cardio-vascular and respiratory disease together accounted for 70 percent of adult deaths in the Kyrgyz Republic in 1994. Death from cardio-vascular disease is higher among women than among men. The next highest in the rank of mortalities come infectious and parasitic diseases including cancer. This is, to a great extent, related to the fact that in rural areas food is less varied, less available and poorer in nutrients. Moreover, rural clinics are inadequately furnished with equipment and qualified personnel, as a result, poorer services are provided. Tuberculosis is not widespread in the Republic but there has been an increase in the frequency of active cases. Brucellosis is not currently widespread either, but with the general decline in veterinary service standards it could become an increasing problem.

The combined impact of social, economic, and other factors upon the health of the population and on the provision of health services has not been positive. In addition to those factors, environmental pollution, labor conditions, life styles, and nutrition exert an impact on health. The consequences of the ecology crisis, environmental pollution, apart from the deterioration of hygienic standards, is having an immediate impact on the health situation.

In a market economy, along with the diversification of ownership, there comes societal restructuring. When government medical services can no longer embrace all patients because of scarce financial resources, it is imperative that private medical practices should be introduced. At the same time the government should maintain severe restrictions for medical practice permits and professional control over the quality of medical service. It is the basic right of every person who needs medical assistance to address a physician he trusts. It is the basic right of every physician to engage in health care activities. Physicians working in state medical establishments should enjoy the right to compensation for making a private call. It is important, however, that each physician obtain a license, thus assuming certain professional, moral and financial responsibilities to his colleagues, to his patients, and to the State.

Ecology

In the Soviet Union, Kyrgyzstan was a supplier of strategic raw materials. Unfortunately, the environment was neglected in the mining of uranium and other rare metals. Upon independence, the Kyrgyz Republic inherited 42 deposits of uranium waste and some cases of radon-polluted water and air. Excessive chemicals introduced into the soil as fertilizer and pesticides has caused a reduction of soil fertility. Improper control of irrigation systems led to the salination of previously fertile lands. Out of over a million hectares of irrigated land, approximately 380,000 hectares were partially polluted by remnants of pesticides and not less than half have undergone erosion.

The Kyrgyz Republic possesses rich water resources, the annual flow is about 11.5 billion cubic meters. Kyrgyzstan was the highest among the Soviet Republics with respect to fresh water resources. Despite the great amount of water resources, the problem of efficient utilization is of great importance. The coefficient of useful utilization of the water in the agricultural sector is 0.53. Clean water is also a problem. Laboratory tests have shown that in urban areas approximately 12.5 percent of the water contains biological contaminates and over 3.5 percent is chemically polluted. There is no systematic control of ground and surface water near the wastes from the mining dumps.

The Kyrgyz Republic forests are key regulators of the climate, water regime and soil erosion. In 1973 the forests covered 1194 thousand hectares of land. In 1993 the area under forests is reduced to 1091 thousand hectares. Industrial cutting of forests in the Republic is prohibited. However, in the past three years people have been cutting down trees to heat their homes and in many cases trees are cut as cheap construction material.

In recent years damage to the balance between vegetation and animal life has been observed. About 15 percent of the mammals and 10 percent of the birds are being threatened.

Ecological consequences should be taken into account when prospective industries are considered. This refers to the Kamin Karbide plant to the Issyk-Ata fur coats factory, the Tokmak crystal factory, the asphalt plant and wool-processing factories in the Tonsk district, and the Kara-Kol alcohol plant.

Human Security

The incidence of homicide in the Kyrgyz Republic has been sharply increasing in recent years. In 1991 there were 397 murders in 1994, 621. The highest number of homicides occurred in Bishkek, 214, and Chui Oblast, 161. In 1993, the number of suicides equalled the number of murders. This is a very dangerous symptom indicative of the economic depression spreading into a wider psychological depression. If there is not a direct campaign against this violence and lawlessness, the loss to society could be substantial. There is a tendency for the population to loose their psychological stability.

Housing was always a problem in the large soviet empire and the newly independent states have inherited this problem. In the past, state programs of housing construction lagged behind the growth of the population. Currently, the attempts of the government to remove from their shoulders the burden of housing construction has not been successful. The scale of private entrepreneurial possibilities are small and privatized construction enterprises have concentrated on commercial construction. The compensatory role of migration in making empty apartments available was small and has begun to drop. The reduction in the growth of the population will not begin to reduce housing requirements for many years. Meanwhile, the lack of housing can be an additional source of social tension.

Another human security issue today in the Kyrgyz Republic is security for ethnic groups and communities. Inter-ethnic relations today are extremely multi-faceted. Representatives from over 80 nationalities reside on the territory of Kyrgyzstan. The Kyrgyz Republic is distinguished from its neighbors to the south because the indigenous ethnic group here constitutes a rather small portion of the total. The percentage of Kyrgyz in the population is 58.6 percent.

Several principles form the basis of the official policy regarding ethnic communities: 1. the recognition of the priority of human rights over ethnic rights; 2. the free development of each ethnic community within the framework of democratic processes and understanding that in a multi-ethnic republic, no single ethnic group can put its requirements ahead of those of the Republic or at the expense of violating the interests of another group; 3. the understanding that the people of the Kyrgyz Republic are an organic merger of many ethnoses to form a single country. No persecution of communities for religious faith has been observed in the Republic. Political security in 1994 did not cause significant apprehension, though the risk of ethnic conflicts and social instability has not disappeared.

In order to improve the prospects for personal and community security chaos should be reduced to a minimum. Economic, political and social stability are important. Control over the social order has weakened and violations have become more frequent and the economic consequences of privatization were of an irregular character.

Conclusions

Another commonality across all spheres is the need to integrate market forces and private ownership into the provision of service. Each sector has, to a varying extent, attempted to introduce some privatization. This process, however, is proving to be difficult and will not be complete for many years. The challenge is to somehow maintain an appropriate level of service, especially for those who cannot afford to pay, while simultaneously introducing incentives for providers and users of services to exploit the free market.

National priorities in the sphere of human development are the following: preservation of the health service, education, culture and science, guarantee a future for the children, and social support for pensioners and those not able to work during the economic crisis. Among these, the very highest priority must go to education and the protection of mothers and children. The first priority in health care is preventative measures.

What steps and measures are required to be undertaken by the Government of the Kyrgyz Republic in order to slow down any further catastrophic deterioration of science, education, culture and health service?

First of all, expenditure quotas per student should be established in the educational sphere below which financing would not be allowed to fall. Similarly there should be quotas for science for each scientific specialist. For culture and health the quotas would be established per capita. These quotas would be increased as improvement of economic conditions allowed. Today we are still at the lowest level below which human development financing should not drop. From this expenditure, salaries of professionals working in health, education, science and culture should be increased.

With economic freedoms and multiple forms of ownership given to enterprises, any financing of the private sector from the state budget should be halted so these enterprises learn better how to deal with the market-oriented economic environment. High interest credits should replace government credit lines which would be restricted. Budget funds should primarily serve human development objectives. Industries should be able to fend for themselves without interest-free funding from the government.

Recommendations to international organizations and funds, foreign governments

2. Provide social sphere human resource training and re-training both locally and overseas. Help with Russian/Kyrgyz translation and publication of Western scientific and educational literature.

3. Any food aid should be restricted to certain social and age groups. If possible it should be directed to specific regions and be kept from falling into the wrong hands. Holes in the distribution system should be blocked so the intended beneficiaries receive the aid.

4. The credit should be directed to industries, the majority to the private sector.

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